The Effectiveness of the Nurse Care Coordinator Role on Patient-Reported and Health Service Outcomes: A Systematic Review

This systematic review examined the effectiveness of nurse care coordinator (CC) roles on patient-reported and health service outcomes. Multiple electronic databases (Medline, CINAHL, and EMBASE) were searched and the Cochrane Risk of Bias Assessment Tool was applied by two independent reviewers. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the quality of evidence. A total of 45 articles (reporting on 36 studies) were included. The majority of studies ( n = 28, 78%) were conducted in the United States and published after 2009 ( n = 24, 67%). Thirteen studies (36%) used a randomized controlled trial design. A total of 17 studies evaluated patient-reported outcomes and 29 studies reported health service outcomes. The individual components of nurse CC roles that were evaluated ranged considerably. The impact of nurse care coordination on patient-reported and health service outcomes was inconsistent. There was an indication from higher quality studies that nurse care coordination roles were more likely to result in improved patient and health service outcomes where they involved frequent, in-person interactions, had ongoing follow-up with monitoring of disease status, and involved transition care and the application of behavior change principles.

Asthma management practices among children in Georgia

BACKGROUND

Asthma self-management, the involvement of patients or their caregivers in the management of their disease, reduces healthcare visits and costs. We assessed selected asthma self-management practices among a representative sample of children in Georgia to guide statewide asthma control programs.

METHODS

A random-digit-dialed telephone survey of 2,121 households with 3,896 children 17 years of age or younger was conducted. Primary caretakers were asked about asthma and medication use of their children. Child data were weighted according to the number of telephone lines in the household and to the 2000 Georgia Census population.

RESULTS

Approximately 10 percent of children in Georgia had asthma. Among children with asthma, 30 percent did not have regular asthma checkups and 66 percent did not have a written management plan; 19 percent filled 2 or more prescriptions per year for quick-relief medicine but did not take control medication. For children with asthma for whom tobacco exposure was a known trigger, 35 percent were exposed to tobacco smoke in the home.

CONCLUSIONS

Opportunities exist to improve self-management, pharmacotherapy, and exposure to triggers for children with asthma. These data can be used to guide organizations and agencies working to reduce the burden of asthma.

The impact of a large-scale population-based asthma management program on pediatric asthma patients and their caregivers

BACKGROUND

The consequences of pediatric asthma include missed school attendance, limitations in physical activity, and increased health care utilization and costs. Caregivers of asthmatic children are affected through missed work days and decreased job productivity. In response to these issues, a disease management program encompassing asthmatic children and their caregivers was developed as part of the core services offered to members of a large, national health care plan.

OBJECTIVE

To determine the impact of the asthma management program on pediatric asthma patients and their caregivers over a 12-month period.

METHODS

In this longitudinal study, 401 randomly selected member households with asthmatic children from 17 regional markets completed surveys before and after 12 months of participation in the asthma management program. Program interventions, which were tailored according to risk and need status, included various staggered educational mailings, reminder aids, videos, a peak expiratory flow rate meter, and telephonic case management. The Asthma Quality Assessment System survey, a battery of self-reported quality indicators, was used to solicit information from parents or caregivers of asthmatic children on issues pertaining to quality of life, asthma management skills and knowledge, and lost work/school days related to asthma.

RESULTS

Statistically significant postprogram outcomes were observed in various domains, including a reduction in adverse utilization, symptomatology, and restricted activity days for children and lost work days for adult caretakers.

CONCLUSIONS

These findings demonstrate that a large-scale population-based intervention program can produce measurable clinical and economic benefits, thereby lessening the burden of asthma on the family unit.